紧闭式吸入麻醉的原理及实施方法

紧闭式吸入麻醉方法有其他方法无法比拟的特点。麻醉气体监测仪器不断完善和普及使这种麻醉方法能更加安全，实施更方便。对紧闭式吸入麻醉的原理及实施方法进行了简要总结。     

紧闭式吸入麻醉的原理及实施方法

紧闭式吸入麻醉方法有其他方法无法比拟的优点。麻醉气体监测仪器不断完善和普及使这种麻醉方法能更加安全,实施更方便。对紧闭式吸入麻醉的原理及实施方法进行了简要总结。     

N2O小流量循环紧闭式吸入全麻的临床应用

N_2O吸入全麻日渐普及,但在没有氧监测时能否安全应用N_2O小流量紧闭式吸入全麻尚有疑虑。本科施行N_2O小流量吸入全麻787例,对其中113例进行了吸入氧分量(FiO_2)监测和部分血气分析,证实此法安全可行,报告如下。一般资料男492例,女295例。年龄13～75岁。体重34～80kg。手术种类,颅脑手术266例,骨科手术211例,腹部手术145例,脑科手术77例,其他88例。手术时间为1h40min～4h50min。麻醉机为北美     

注入法七氟醚紧闭环路麻醉

注入法紧闭环路吸入麻醉时 ,为了探索更符合麻醉药药代动力学特征和临床麻醉实践的计算方法 ,我们在麻醉药药代动力学模型模拟结果的基础上设计出自己的投药方案 ,现报告如下。麻醉方法　术前用药阿托品0 5ｍｇ、安定 10ｍｇ肌注 ,麻醉诱导前静注芬太尼 1 5 μｇ·ｋｇ-1静脉快速诱导、异丙酚 2ｍｇ·ｋｇ-1,入睡后琥珀胆碱 1 5ｍｇ·ｋｇ-1静注行气管插管 ,肺及食管手术行双腔管插管 ,接ＤａｔｅｘＡｓ 3多功能监测仪采样头 ,机械通气 ,潮气量 10ｍｌ·ｋｇ-1,呼吸频率固定 ,呼气末ＣＯ2 维持在 35～ 40ｍｍＨｇ。Ｐ Ｖ环证实无漏气后以新…     

安氟醚低流量紧闭麻醉的临床观察

目的和方法：采用低流量（０．２Ｌ／ｍｉｎ）新鲜气体（氧）与安氟醚麻醉，并与高流量（２Ｌ／ｍｉｎ）安氟醚麻醉者比较。监测气管插管后５ｍｉｎ、１０ｍｉｎ、１５ｍｉｎ、３０ｍｉｎ和６０ｍｉｎ直至术终的ＭＡＰ、ＨＲ、ＳｐＯ２、Ｆ１Ｏ２、ＰＥＴＣＯ２、Ｆ１Ｅｎｆ、ＦＥＴＥｎｆ及新鲜气体流量。记录手术结束至拔管的时间及清醒程度。结果：两组差异均无显著性意义（Ｐ〉０．０５）。结论：低流量新鲜气体麻醉与高流量同样     

吸入氧化亚氮或非氧化亚氮麻醉下气管导管囊内压力的变化

气管插管囊内气体外漏可致气道封闭不严或由于氧化亚氮 (Ｎ2 Ｏ)向含气腔渗透 ,使囊内压升高而损害气管粘膜。本文旨在研究Ｎ2 Ｏ和非Ｎ2 Ｏ麻醉下囊内注入不同气体对囊内压变化的影响及预防囊内压变化的措施。临床资料　ＡＳＡⅠ～Ⅱ级病人 45例 ,其中择期腹部手术 31例 ,四肢手术11例 ,乳腺手术 3例 ,随机分成两组 :Ｎ2 Ｏ组 (2 3例 )和非Ｎ2 Ｏ组 (2 2例 )。麻醉时间 <2ｈ者除外。麻醉方法　气管插管静吸复合麻醉。导管内径男 7 5～ 8 5ｍｍ ,女 7 0～8 0ｍｍ。监测心电图 (ＥＣＧ)、血压 (ＢＰ)和脉搏氧饱和度 (ＳｐＯ2 ) ,开放静脉通路…     

地氟醚-氧化亚氮低流量麻醉

地氟醚是八十年代末新开发的卤化醚类挥发性麻醉剂,肺泡平衡快,诱导/苏醒迅速、体内几无代谢,生理干扰小[1]。近年国外文献较多,国内报道尚少。我院于1998年3月引进英国ZENECA公司生产的地氟醚(Desflu-rane)并临床试用,效果满意,报告如下。资料与方法一、一般资料　48例择期全麻下手术成年病人,ASA～级。年龄(20～70)(48±14.3)岁;体重(50～84)(63±10.3)kg。上腹部手术21例、眼眶手术13例、食管、肺手术8例、盆腔和下肢手术6例,术前心、肝、肾功能正常。二、麻醉方法　(1)麻醉前用药:所有病人麻醉前半小时口服安定5mg、肌注阿托品0.01m…     

不同频率紧闭循环通气用于婴儿麻醉的比较

90年代末期，麻醉机技术进步大幅提高，即高精度双环路呼吸监测探头与呼吸控制联体，使得成人麻醉机可直接用于婴儿。本文似观察婴儿麻醉时，不同频率紧闭循环通气，对呼吸动力学和肺内气体交换的影响，从而为婴儿麻醉合理设置呼吸参数提供参考。     

Priming of Anesthesia Circuit with Xenon for Closed Circuit Anesthesia

Abstract: Xenon is an inert gas with a practical anesthetic potency (1 MAC = 71%). Because it is very expensive, the use of closed circuit anesthesia technique is ideal for the conduction of xenon anesthesia. Here we describe our methods of starting closed circuit anesthesia without excessive waste of xenon gas. We induce anesthesia with intravenous agents, and after endotracheal intubation, denitrogenate the patient for approximately 30 min with a high flow of oxygen. This is done to minimize accumulation of nitrogen in the anesthesia circuit during the subsequent closed-circuit anesthesia with xenon. Anesthesia is maintained with an inhalational anesthetic during this period. Then, we discontinue the inhalational agent and start xenon. For this transition, we feel it is unacceptable to simply administer xenon at a high flow until the desired endtidal concentration is reached because it is too costly. Instead. we set up another machine with its circuit filled in advance (i.e., primed) with at least 60% xenon in oxygen and switch the patient to this machine. To prime the circuit, we push xenon using a large syringe into a circuit, which was prefilled with oxygen. Oxygen inside the circuit is pushed out before it is mixed with xenon, and xenon waste will thus be minimized. In this way, we can achieve close to 1 MAC from the beginning of xenon anesthesia, and thereby minimize the risk of light anesthesia and awareness during transition from deni-trogenation to closed-circuit xenon anesthesia.     

Nitrous Oxide and the Inhalation Anesthetics

Nitrous oxide is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably, but it may be combined with other inhalation and/or intravenous agents in deep sedative/general anesthestic techniques. However, as a single agent, it has impressive safety and is excellent for providing minimal and moderate sedation for apprehensive dental patients. To gain a full appreciation of the pharmacology, physiologic influences, and proper use of nitrous oxide, one must compare it with other inhalation anesthetics. The purpose of this CE article is to provide an overview of inhalation anesthetics in general and to address nitrous oxide more specifically in comparison.     

低浓度可调笑氧混合气体镇静、镇痛联合利多卡因局部浸润麻醉在肛门直肠手术中的应用

目的探讨低浓度笑氧混合气体镇静、镇痛联合利多卡因局部浸润麻醉在肛门直肠手术中的应用价值。方法将在笔者所在医院接受肛门直肠手术的300例患者分为对照组154例和观察组146例。对照组采用单纯利多卡因局部浸润麻醉,观察组采用低浓度笑氧混合气体镇静镇痛联合利多卡因局部浸润麻醉,比较2组患者术前及术后生命体征的变化及其镇静、镇痛效果。结果所有患者均完成肛门直肠手术。对照组与观察组相比,其手术前后心率、血压及血氧饱和度变化的差异均无统计学意义（P〉0.05）;对照组和观察组的手术操作时间分别为（36.3±6.8）min与（35.4±6.5）min,差异无统计学意义（t=0.607,P=0.544）;观察组的镇痛效果（Z=-6.859,P=O.000）及镇静效果（Z=-5.275,P=-0.000）均优于对照组。结论低浓度笑氧混合气体镇静、镇痛联合利多卡因局部浸润麻醉较单纯利多卡因局部浸润麻醉,其镇痛及镇静效果均较好,患者术中和术后生命体征平稳,使用安全,值得临床推广应用。     

循环密闭异氟醚注入剂量及摄取的研究

30例成年手术病人用循环密闭环路内注入异氟醚维持麻醉。用CAPNOMAC气体监测仪连续监测呼吸道内异氟醚浓度,维持呼气末浓度(C_E)在1±0.2%。根据时间平方根计量原则计算每个间隔单位量,得出间隔单位量在开始30min明显少于30min后,30min后间隔单位量基本恒定,与时间平方根原则相符。异氟醚摄入量及摄入率随时间变化均分快慢两个时相,实测值与曲线方程计算值相近。根据异氟醚注药及摄取规律可安全使用异氟醚注入麻醉。     

地氟醚环路内注药法循环紧闭吸入麻醉的应用研究

目的：探讨地氟醚环路内注药法用于循环紧闭吸入麻醉的可行性,并观察地氟醚药代动力学的变化。方法：５０例ＡＳＡⅠ～Ⅱ级择期手术全麻病人,咪唑安定、芬太尼麻醉诱导插管行ＩＰＰＶ。氧流量４Ｌ／ｍｉｎ通气５分钟,行最低流量循环紧闭吸入麻醉。根据Ｌｏｗｅ的吸收公式,通过呼气端注入地氟醚的初始剂量,接着用微泵持续输入地氟醚,维持地氟醚的肺泡浓度（ＦＡ）约３％左右,术中根据地氟醚的ＦＡ调整输注速度。切皮前静注芬太尼０１ｍｇ,术中维库溴铵维持肌松,并辅以异丙酚２ｍｇ·ｋｇ－１·ｈ－１。记录地氟醚ＦＡ达３％的时间、呼气末浓度／吸气浓度（ＦＩ）达０８５的时间及其变化趋势。结果：地氟醚用量１０２４±１６３ｍｌ,地氟醚ＦＡ达３％的时间为１１±０４分钟,ＦＡ／ＦＩ达０８５的时间为３１±０１分钟,并能维持于０８５～０９５,恢复呼吸为５７±１３分钟,拔管时间为８３±０９分钟,睁眼时间８６±１６分钟。结论：采用低流量循环紧闭环路内注药法能安全有效地实施麻醉和减少环境污染。     

闭合环路定量输入七氟醚法及耗药量的探讨

目的 :采用Lowe方式施行密闭循环回路内定量麻醉 (CCA) ,并与常规挥发罐密闭循环麻醉方式比较 ,探讨七氟醚药量的消耗。方法 :42例ASAⅠ～Ⅱ级病人 ,随机分为两组 :Lowe方式组及常规挥发罐组。术中记录呼气末七氟醚浓度 ,并计算 12 1分钟时间内耗药量。结果 :Lowe方式在 9分钟达到预定值 ,挥发罐组在 36分钟达到预定值。12 1分钟时间内七氟醚耗药量在Lowe方式组为 8± 1ml,挥发罐组为 16± 2ml。结论 :Lowe方式较挥发罐法吸入速度快 ,更能节省用药量。     

Effect of Nitrous Oxide on Spike Activity During Epilepsy Surgery

Summary. There are controversies over the effect of nitous oxide on the electrocorticograms in patients with epilepsy. To clarify the effect of nitrous oxide on electrocorticograms, spike activities were compared with and without nitrous oxide under neuroleptoanesthesia in 10 patients with intractable epilepsy during surgery. Spikes decreased with nitous oxide significantly (P<0.01) and disappeared in 3 cases. We conclude that discontinuation of nitrous oxide should be taken into consideration during electrocorticographic monitoring in epilepsy surgery.     

低流量氧异氟醚紧闭吸入麻醉在心脏手术中的应用

本文报告在旁气流气体监测仪监测下，使用持续气流麻醉机和注射泵，在１４例心脏直视手术中施行低流量氧－异氟醚紧闭吸入麻醉的结果。于气管插管后关闭麻醉环路，依Ｌｏｗｅ的ｋｇ３／４法则和时间的平方根法则，按计算的通气量和给药量实施。结果表明：关闭环路后，环路内氧分量（ＦｉＯ２、ＦＥＯ２）逐渐下降，于９ｍｉｎ即与关闭前有非常显著的差异（Ｐ＜０．０１），异氟醚于１６ｍｉｎ达到预期浓度（１．３±０．４ＭＡＣ），ＳｐＯ２均≥９８％，血压、心率维持稳定。根据结果认为，在全面监测的基础上，即使对心功能很差的心脏病人，也可安全实施低流量紧闭吸入麻醉。     

Nitrous oxide pneumoperitoneum revisited

Nitrous oxide has been effectively banned from use in therapeutic laparoscopy because of fear of combustion. These fears rest on two case reports, a misunderstanding of the physical chemistry of nitrous oxide, and lack of information on the presence of flammable colonic gases in the pneumoperitoneum mixture. This study aims to identify the presence and quantify the amount of hydrogen and methane found in the peritoneal cavity during laparoscopic GI procedures, and then to compare the gas concentrations detected with known limits of combustion. Gas standards with known concentrations of hydrogen and methane were placed in polypropylene syringes and analyzed on a mass spectrometer after 1, 2, 3, and 4 h. This established the rate at which these gases would be leached through a polypropylene syringe—the amount of gas lost during transport from the patient to the laboratory. Twenty gas samples were drawn, randomly, 30 min to 2 h following the start of laparoscopic gastrointestinal procedures. The samples were analyzed for hydrogen and methane within 30 min of their aspiration from the abdominal cavity. An inconsequential amount of methane was lost from the polypropylene syringe in 4 h. After 1 h, one-half the hydrogen had leached from the polypropylene syringe. Hydrogen was detected in the pneumoperitoneum of four patients at a concentration ranging from 0.016 to 0.075%. No methane was detected in any sample. For combustion to occur in a nitrous oxide environment, hydrogen or methane must occupy 5.5% of the gas volume. The maximum amount of hydrogen we detected was less than 1/50 of the combustion threshold. After considering these data, and a large clinical experience of gynecologic laparoscopy using electrosurgery in a nitrous oxide pneumoperitoneum, we conclude that nitrous oxide can be safely used for creating a pneumoperitoneum during laparoscopic surgery.Presented as a poster at the annual meeting of Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Phoenix, Arizona, USA, 2–3 April 1993